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Girls at much greater depression risk when experimenting with alcohol, drugs and sex

Not really convinced by any of this and if you read where the funding for this research is coming from, you can see how the research may well have been skewed from the start. This from http://www.pire.org/ :

Girls at much greater depression risk whenexperimenting with alcohol, drugs and sex
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Risky behaviors are symptoms that require screening, study says
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CHAPEL HILL – New research shows that when teen-age boys and girls experiment with sex,drugs and alcohol, girls are at much greater risk of depression than boys.
The study from PIRE Chapel Hill Center found that ​

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if girls and boys abstain from these
behaviors, their risk for depression doesn't significantly differ, which is contrary to the widelyheld
assumption that girls are more prone to depression than boys. However, as soon as they both
start experimenting, even only occasionally, girls become more depressed than boys, according
to the study published this month. At higher levels of substance abuse and sexual activity among teens,
boys and girls show similar levels of depressive symptoms.
While all teens engaging in higher levels of alcohol and drug use and sexual activity should be
screened for depression, girls, in particular, should be screened even if they are only experimenting, said
Martha Waller, Ph.D., the study’s primary investigator.
“What’s interesting is that just being female does not necessarily put you at a greater risk for
depression, which has generally been assumed,” she said. “At puberty, we see that the prevalence of
depression starts to greatly increase in girls but not in boys, and this gender difference has always been
attributed to developmental changes in girls such as hormonal changes. But in this study, we find that for
girls who have not experimented with smoking or drinking or become sexually active, their risk for
depression is no greater than males, regardless of their developmental status.”
Published this month in Archives of Women’s Mental Health, the study of nearly 20,000 teens
showed that girls who used alcohol, tobacco and drugs only occasionally are 2½ times as likely to show
signs of depression as teen girls who abstained. When girls experiment with sex, they are 3½ times as
likely to experience depressive symptoms as those who abstain, according to the research, which was
funded by the National Institute on Drug Abuse.
While girls experience significantly more depressive symptoms than boys at low levels of alcohol
and drug use and sexual activity, boys who engage in these risk behaviors still experience more
depressive symptoms than those who abstain. For both girls and boys, the depressive symptoms generally
increased as risk behavior increased. Girls who used marijuana regularly were almost nine times as likely
to experience depression, and those who used IV drugs were nearly 18 times as likely to suffer from
depression compared to girls who did not, the study found. Boys who binge drink are about 2½ times as
likely to be depressed, while those who regularly use marijuana are five times as likely, and those who
use intravenous drugs are six times as likely, to show symptoms of depression compared to boys who
abstain completely.
Both substance abuse and sexual activity may alter a girl’s social context, which could induce
stress and change self-perceptions, both of which could contribute to depression, Waller said. In addition,
there may be differences in how girls and boys physically respond to substance use that help explain the
sex differences, she said.
Other research last year from PIRE Chapel Hill Center showed that sex, drugs and alcohol among
teens actually precede – and apparently lead to -- the onset of adolescent depression, which contradicts
the common belief that depressed teens may be “self-medicating” through substance abuse and sex.
PIRE, or Pacific Institute for Research and Evaluation, is a national nonprofit public health
research institute with centers in eight U.S. cities that is supported primarily by federal and state research
and program funds.​

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Here's another article from the Wisconsin State Journal. It has a few more details about the study.

In Teen Girls, Depression And Risky Behavior Might Goby Nancy Webb, For the State Journal, (05 Jul 2006)Wisconsin State Journal Wisconsin
Somewhere within the messy American intersection of gender, adolescence, sex, drugs and cultural messages, researchers have located what they are carefully defining as an "association": Sexual activity and experimentation with illicit substances may put a teenage girl at significantly greater risk for depression than a teenage boy who engages in the same behaviors.

This research also takes the widely held perception that teens who are depressed engage in risky behaviors as acts of "self-medication," and suggests that depression can also be the consequence, not just the cause, of experimentation our culture regards as both morally deviant and normal.

"Adolescents do the things adolescents do," says Martha Waller of the Pacific Institute for Research and Evaluation at Chapel Hill, N.C.

Waller is the lead researcher of a study recently published in "Archives of Women's Mental Health" and immediately distributed by mental health agencies nationwide. Once a high school teacher, Waller knows it's the rare adolescent who never tries a cigarette, drinks alcohol, inhales marijuana or becomes sexually active to some degree.

These activities may be "developmentally appropriate" in our culture, but at the same time, each carries risk.

"Abstainers," as she calls them, who avoid the risk by avoiding the behavior, actually come to be regarded as "abnormal" as they reach upper teens, where "they certainly become the minority."

Yet it appears that this generalized abstinence confers, at least statistically, some inoculation against symptoms of depression.

"The longer you can hold them off, the longer they have for emotional and physical development, the better," Waller says.

Looking at the study

The study's name is as ambitious as its topic: "Gender differences in association between depressive symptoms and patterns of substance abuse and risky sexual behavior among a nationally representative sample of U.S. adolescents."

Funded by the National Institute for Drug Abuse, the study also used data from the National Institute of Child Health and Human Development. It is the "gender difference" aspect that struck the researchers as most significant.

If teenagers are especially prone to depression ( about one in four report symptoms, ) and women are more ( about twice as ) prone to depression than men, it should not be surprising that teenage girls suffer more symptoms of depression than teenage boys.

Sure enough, "At puberty, we see that the prevalence of depression starts to really increase in girls but not boys, and this gender difference has always been attributed to developmental changes in girls such as hormonal changes," Waller says. "But in this study, we find that for girls who have not experimented with smoking or drinking or become sexually active, their risk for depression is no greater than males, regardless of their developmental status."

In short, she says, "just being female does not necessarily put you at greater risk for depression."

Other factors involved

However, being female and engaging in one or more risky behaviors - the study looked at 16, ranging from infrequent cigarette smoking to having sex for drugs or money - apparently can lead to depression, more so than in male adolescents who behave the same ways.

Why would that be? It's possible there are gender differences that make alcohol or nicotine or any drug react differently with brain chemicals, Waller says, but "we really don't know what makes males less vulnerable or females more vulnerable. As much progress as we've made, there is still a 'boys will be boys' mentality. In sexual activity, girls bear the greater burden. But even though there are quantifiable societal differences, I'm guessing it's more complicated than that."

Complicated it is: The study notes that the rate of depression among adolescent females appears to increase with age; depression rates decrease as adolescent males get older. American girls generally have puberty before boys, throwing them into what Waller calls "an entirely new social context, where older boys are paying attention to them at a time when they're still relatively undeveloped."

Add to that the fact that brain structure and chemistry may be affected by cortisol or oxytocin, hormones produced by experience, such as romantic or sexual involvement, or stress, perhaps the stress of risking personal harm or societal or parental disapproval.

What to do

The study has several specific recommendations, but waving the results in front of a daughter to say, "Don't experiment with anything, ever, or you'll become depressed" is not one.

Findings "could easily be misconstrued," Waller admits, "but that's certainly not what we're trying to do." She believes parents navigate a fine line between wanting to influence their teenagers yet believing they have no influence.

"They either say, 'I can't tell them anything,' so they stop trying, or they try to control everything. You can't control every aspect of your teenager's life. But I believe parents get to say, 'This is what I expect of you,' and do it early, before they start. Say, 'I would be disappointed if you did these things.'

"Not that smoking is ever good for you, but it is legal; not that sex should be avoided forever; drinking alcohol may be something you do at some point. It's just that at this point in your life, I expect you to abstain, and here's why.'"

The study reported:

Girls who only occasionally used alcohol, tobacco, or drugs are two and a half times more likely to suffer depression than girls who abstained.

Girls who used marijuana regularly were almost nine times as likely to have symptoms of depression than girls who abstained.

Girls who used IV drugs were nearly 18 times as likely to suffer depression compared to girls who abstained.

Generally, the more "deviant" the behavior, the greater the risk of depressive symptoms.

In short, the greatest amount of gender-related depression appeared to follow low and moderate levels of risky behavior.

There was no significant difference in depression rates among teenagers of both genders who abstained. Involvement in risky behaviors at low or moderate levels brought about a greater chance of depression among girls. With high levels of risky behavior, the gender difference was, as with abstainers, not significant.

Consider other factors

Dr. David Skripka is a UW Health psychiatrist with nine years of experience with adolescents and their emotional and behavioral issues. He points out that the study correlates risky behavior and symptoms of depression, but doesn't take the next step of determining whether it correlates to clinically diagnosed major depression.

He also notes there are disorders and early life experiences, other than risky behavior, that could predispose a growing child to engage in such behaviors and also become depressed - the death of a parent, for example, or imbalances in brain systems that manage pleasure and reward.

Dr. Peter Lake, medical director of Rogers Memorial Hospital-Oconomowoc and its Child and Adolescent Center, also raises questions about the study.

"I'm a bit skeptical about the study. It's difficult to say what came first," he says. "We do see more that girls with drug and alcohol issues are more susceptible to depression and anxiety, but at the same time, a lot look like that but when the dust settles," he says, the staff discovers that depression preceded the drug and alcohol use.

Waller acknowledges the study's limitations, noting that research is always a process of uncovering new areas for research. The next push, she suggests, needs to be in treatment research.

"If we treat mental health, does the substance abuse stop?" she says. "If we treat the substance abuse, does the depression go away? That's where we really need to go now. Possibly, we need to treat both at the same time."

That's exactly what happens at Rogers Memorial, in contrast to many of the 12-step programs that focus on drug and alcohol use but don't address depression beyond having a psychiatrist oversee anti-depressant medications, Lake says.

Also, if an adolescent is treated only for the depression, other issues - including but not limited to drug and alcohol use - can be missed.

"There's clearly an issue of girls with substance abuse that get over their heads in a hurry, then things happen that they wish didn't happen," he says.

He is referring to situations he hears about, such as teens hanging out in a friend's basement when pot, alcohol, OxyContin or some other drug is available and the friends-with-benefits expectation kicks in or perhaps a girl is sexually abused.

Lake also has encountered teenage girls who have completed a 12-step program or one of the wilderness experience programs addressing alcohol and drug use.

"They say their substance abuse is better, but boy are they depressed," he says. "Then I find out they had three or four encounters with guys," either when they were high or when they were passed out and think "something happened."

Another issue often missed when depression only or substance abuse only are treated is attention deficit hyperactivity disorder ( ADHD ), Lake says.

"They migrate to becoming very depressed and the substance abuse crowd is accepting - or use helps them deal with social pain."

Whether the correlations ever evolve into cause-and-effect evidence, one Madison 15-year-old ( who, like the others quoted, wanted to remain unidentified ), said the study's findings rang true: "Whenever I see kids using drugs or beer or cigarettes, deep down, I know they're not really happy."

Slumped like rag dolls in a circle of mismatched sofas and chairs, seven Dane County adolescents wait silently. The grown-up arrives. They sit a little straighter.

"I'll start. I'm Shelly. Drug of choice, cocaine. I've been straight for 22 years. I wanted to make a safe place for young people to go so they could become functional with life and feelings without drugs."

Connections Counseling, which Shelly Dutch founded and has directed for the past four years, offers group and individual counseling for teenagers who are recovering from alcohol and drug use.

"I was in middle school," Dutch continued, "not depressed but insecure. I felt like my dad liked my brothers better. I wasn't popular. I was a little chunky. Drugs did something for me I could not do for myself."

One by one, girls and boys ages 15 through 18 put their stories into the circle. Drugs of choice: marijuana, cocaine, heroin, alcohol, psychedelic mushrooms. Straight and sober 98 days. Three weeks. One and a half days.

"My depression definitely came first," followed by cocaine and heroin, an 18-year-old said. "I was diagnosed with depression when I was 10. You can't cure depression until you cure the drug dependency."

Far from cured, having been through multiple detoxifications, he was on his way to an out-of-state facility that specializes in particularly difficult cases of dual diagnosis with a strong focus on depression.

"I never felt depressed at all before I started using," said a 15-year-old. "And I wouldn't say I'm an unhappy person, now. But I wouldn't say that using made me a happier person, that's for sure."

This particular group session included a 17-year-old girl's graduation: To mark her three months of sobriety, there was pepperoni pizza all around. Her mother and baby sister joined the celebration.

"My wish for you," the mother struggled to communicate to her daughter through tears, "is that you will really understand your worth, your value as a person, all the great attributes you have, and not put yourself into any situation where you might do anything self-destructive."

Baby Sister sat nestled between the teenager and her mother, watching, listening, learning. The ones who had been straight only a few days watched and listened to the one who had made it to three months. On the wall hung photographs of graduations for those who reached one year.

The treatment plan is to instill enough hope to get through the day, one day at a time, until days pile up into months, years, life.

Thousands of genes behave differently in the same organs of males and females, researchers have reported, a finding that may help explain why men and women have different responses to drugs and diseases.

Their study of brain, liver, fat and muscle tissue from mice showed that gene expression - the level of activity of a gene - varied greatly according to sex.

The same is almost certainly true of humans, the team at the University of California Los Angeles reported. "This research holds important implications for understanding disorders such as diabetes, heart disease and obesity, and identifies targets for the development of gender-specific therapies," said Jake Lusis, a professor of human genetics who worked on the study.

Writing in the August issue of Genome Research, the researchers said that even in the same organ, scores of genes varied in expression levels between the sexes. The smallest differences were in brain tissue, they found. "We saw striking and measurable differences in more than half of the genes' expression patterns between males and females," said Dr. Thomas Drake, a professor of pathology. "We didn't expect that. No one has previously demonstrated this genetic gender gap at such high levels."

Xia Yang, a postdoctoral fellow in cardiology who led the study, said the implications are important. "Males and females share the same genetic code, but our findings imply that gender regulates how quickly the body can convert DNA to proteins," Yang said in a statement. "This suggests that gender influences how disease develops."

In liver tissue, the findings imply male and female livers function the same, but at different rates. "Our findings in the liver may explain why men and women respond differently to the same drug," Lusis said. "Studies show that aspirin is more effective at preventing heart attack in men than women. One gender may metabolize the drug faster, leaving too little of the medication in the system to produce an effect."

Yang added, "Many of the genes we identified relate to processes that influence common diseases. This is crucial, because once we understand the gender gap in these disease mechanisms, we can create new strategies for designing and testing new sex-specific drugs.